DETAILED ACTION
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Status of Claims
This action is in reply to the amendment filed on 8/27/2025.
Claims 1-4, 6-14, and 16-20 have been amended and are hereby entered.
Claims 1-20 are currently pending and have been examined.
This action is made FINAL.
Domestic Benefit
The ADS filed on 5/22/2024 claims the benefit of Non-Provisional Application 16508258 (filed 7/10/2019) as a continuation-in-part, and in turn to Provisional Application 62696059 (filed 7/10/2018). However, all claims as presently drafted, either directly or through dependence, contain subject matter which is not supported by either of these benefit applications. As noted below, neither of the above-listed applications contains proper support for the calculating and assigning of “competency scores,” nor the “certification model” or “decision model” or the manner in which they are used as presently claimed. As such, all claims as presently drafted are given an effective filing date of 5/22/2024.
Response to Applicant’s Arguments
Domestic Benefit
Applicant asserts that the claims as presently amended are fully supported by “Parent Application 16508256,” providing several unexplained strings of paragraph citations thereto for particular limitations of Claim 1. Examiner finds several of these provided citations to Non-Provisional 16508256 lacking in sufficient disclosure to fully support the respective limitations associated therewith, and Examiner does not find sufficient supplemental disclosure elsewhere in Non-Provisional 16508256 to cure these deficiencies (explained in greater detail below). Additionally, Applicant makes no attempt to evidence support for the claims as presently drafted in Provisional Application 62696059 (filed on 7/10/2018), which Examiner finds falls significantly shorter still in providing such necessary support. As such, even if Applicant’s assertions of support in Non-Provisional 16508256 (filed on 7/10/2019) were correct (which, to be clear, they are not), they would still fall well short of supporting Applicant’s overall contention that Applicant’s claims of benefit “entitl[es] claim 1 to the effective filing date [2018] filing date [sic] of the parent application.”
As noted above, several of Applicant’s argued paragraph citations fall short of fully supporting the claim limitations to which they respectively apply. Generally, Examiner finds that these citations of support read far more into these passages than is actually there, with the claims further developing the broader concepts disclosed therein significantly beyond the manner in which they are described in Non-Provisional 16508256. For example, nothing in the cited paragraphs of Non-Provisional 16508256 or elsewhere therein properly supports the notion of assigning “competency scores” as claimed. Even if Examiner were hypothetically to treat the bare mention of the broader term “expected competency level” (which, to be clear, Examiner does not find sufficient to describe the narrower concept of “competency scores”) in Paragraph 0029 as indicating the same thing, nothing in Non-Provisional 16508256 provides sufficient written description for such a computer-implemented process as per the standards of 112(a) (see, e.g., MPEP 2161.01), thus also resulting in the 112(a) rejection below. As another example, Examiner sees nothing in the cited paragraphs of Non-Provisional 16508256 or elsewhere therein which properly supports either the “certification model” or the “decision model,” much less the manner in which they are respectively used as claimed. As such, the claims as presently drafted are granted an effective filing date of 5/22/2024.
As the claims of benefit were previously denied in the previous Office Action explicitly in relation to the then-claimed machine learning models and functionalities thereof, and as the present amendments appear to attempt to avoid similar denial of perfection of these claims of benefit (though, as noted above, this attempt is unsuccessful) by removing all mention of machine learning from the claims as presently drafted, Examiner finds it pertinent to discuss these machine learning models in relation to the present Remarks. Specifically, the present Remarks make several arguments related to machine learning in relation to 101 and 103 standards, yet as noted above, all mention of machine learning is removed from the claims as presently drafted and the broadest reasonable interpretations of the claims never requires the presence of machine learning (e.g., none of the three presently claimed “models” are claimed such that they are required to take the form of machine learning models, instead for example potentially taking the broader form of mathematical models or collections of associated data). Applicant cannot have it both ways. Either Applicant must draft the claims such that they embody machine learning, in which case Applicant must accept that the claims of benefit cannot be perfected as neither Non-Provisional 16508256 nor Provisional Application 62696059 provide sufficient support for such machine learning applications, or Applicant must draft the claims such that machine learning is not embodied therein (ie: as presently drafted), in which case Applicant must accept that all arguments related to machine learning are irrelevant since the claims do not embody machine learning (ie: as presently argued). Given the various states of disclosure of the present application and its parent applications, both approaches are not possible simultaneously.
Objections
The present amendments to the claims obviate the previous objections thereto; therefore, these objections are withdrawn.
Claim Rejections – 35 USC § 112
Applicant’s 112(f) arguments (which Examiner reminds Applicant are interpretations rather than rejections) appear to misapprehend the standards for 112(f), both in that none of the previous 112(f) interpretations were made due to “means for” claim language (and indeed, the interpretations themselves stated that the interpretations were made despite the lack of such “means for” language) and in that Applicant’s referencing of details regarding these elements found in the specification but not in the claims as then drafted support rather than refute the need for said interpretations. Relatedly, Applicant’s assertions that various “algorithmic process[es]” for respective claim elements “provides sufficient structure” entirely misapprehends these standards, as algorithmic processes fail to describe any structure whatsoever. Similarly, what Applicant describes as “technical structure” fails to represent a “specific system” as asserted, but instead merely describes purpose and/or function of the recited generic placeholder. Applicant is encouraged to carefully review at least MPEP 2181 to properly understand these standards.
Despite these various misapprehensions of 112(f) standards, several newly claimed generic placeholders are as presently drafted modified by sufficient structure to perform the functions respectively associated therewith. As such, these newly claimed generic placeholders (e.g., a first computational analysis system, a service assignment system). Nevertheless, “a telepresence system” remains interpreted under 112(f) for similar reasons as stated in the previous Office Action. See Interpretation Notes section below for more information.
Regarding the previous 112(b) rejection of all claims in relation to the subjective term “primary and basic specialty care provider” (as also previously abbreviated in the claims, “PBSCP”), while Applicant generally correctly paraphrases the standards for indefiniteness of subjective terms found in MPEP 2173.05(b) (ie: “…whether the specification supplies some objective standard for measuring the scope of the term”), none of Applicant’s proffered arguments or citations of the original disclosure properly evidence such an objective standard for measuring the scope of this term. While Applicant correctly notes that “basic care” and “specialty care” are terms of art in the medical fields (something already acknowledged by Examiner in the previous rejection itself), Applicant’s subjective bisecting of the “specialty care” term of art into “basic specialty” and otherwise (previously drafted as “extraordinary”) are not terms of art; therefore, the original disclosure must provide an objective standard for measuring the scope of the term. The original disclosure provides no such objective standard, instead merely providing some limited examples of some discrete services (e.g., X-rays, routine lab work, basic pharmacy, and basic specialty medications, which fall well short of the full breadth of potential healthcare services and do not provide an objective standard by which those services not explicitly listed by Applicant may be determined as within “basic specialty” care or otherwise) which would or would not fall within “basic specialty” care (though the original disclosure also makes clear that the scope of this term may vary in different embodiments), and vague and non-objective language (e.g., “providers who deliver ‘not only primary care but basic specialty care,’” providing services which “operate closer to the top of his or her license,” “handling more procedures than a typical PCP,” etc.) which likewise fails to provide a reader of the claim (even considering the level of knowledge of one of ordinary skill in the art) of the full bounds of this term. These “definitions” provided by Applicant, ignoring that the scope of this term is explicitly asserted to vary in different embodiments of this invention (e.g., as in Fig. 6, the variability and insufficiency of which was already addressed in the previous rejection itself), fall well short of providing an objective standard by which a health-related service may be determined to be within the scope of “basic specialty” care. While an applicant is free to act as their own lexicographer, such terms must be sufficiently definite such that their full scope is clear, e.g., subjective terms must be described such that an objective standard for measuring the scope of the term is provided. Here, Applicant has failed to do so. As such, this term remains subjective and consequently indefinite.
Regarding the subjective term “extraordinary specialist provider” of Claims 2 and 12, Applicant’s arguments are unpersuasive for the same reasons as explained above regarding the subjective term “primary and basic specialty care,” summarily, the descriptions of this term in the original disclosure are exemplary, and its definition (including as presently claimed) as being beyond the capabilities of the assigned PBSCP fails to provide an objective standard due to the subjectivity/indefinite scope of PBSCP. As such, this term remains subjective and consequently indefinite.
Regarding the subjectivity of “the fixed costs necessary to operated the assigned to operate the assigned primary and basic specialty care provider” of Claims 6 and 16, Applicant’s arguments are unpersuasive as Applicant provides no citation to the original disclosure which supplies some objective standard for measuring the scope of the term for similar reasons to those explained above in relation to the term “primary and basic specialty care.” Instead, at best, the provided citations provide some examples of what costs which might be considered in a fee calculation. The “necessity” of such costs for a provider to operate is only mentioned in Paragraph 0029 of Parent Application 16508256 and Paragraphs 0008 and 0036-0037 of the present application, none of which provide such an objective standard against which this necessity may be measured. As such, this term remains subjective and consequently indefinite. However, Examiner notes that the newly drafted term “fixed costs of the certified PBSCP's practice” of the independent claims (to which the term “the fixed costs necessary to operated the assigned to operate the assigned primary and basic specialty care provider” is interpreted as relating back in the presently updated 112(b) rejections, despite the differences in these terms) is not indefinite in the same way. Amending this term in Claims 6 and 16 would correct this issue.
The remainder of the previous 112(b) rejections are obviated by the present claim amendments; therefore, those 112(b) rejections are withdrawn.
Claim Rejections – 35 USC § 101
Applicant’s arguments regarding the 101 analysis have been considered and are unpersuasive.
As a preliminary matter, Examiner notes that Applicant’s discussion of the various steps of the 101 subject matter eligibility analysis do not comport with the step numbering as set forth in the MPEP. Examiner’s discussion below will use the latter numbering for clarity.
Examiner notes generally that nearly every argument presented regarding 101 subject matter eligibility (with the exception of a Step 2B argument regarding Claim 11) all rely in part on assertions related to machine learning. As explained above, no claim as presently drafted embodies machine learning, with the entire concept being stricken from all claims via the present amendments. As machine learning is not embodied in any claim as presently drafted, these arguments are all foundationally flawed and unpersuasive. Examiner further notes that even if such machine learning were properly embodied in the claims (e.g., as in the previous version thereof), this high-level claiming of machine learning models to perform abstract steps (e.g., logical operations, pattern recognition, statistical analyses) absent any technical details as to how said machine learning models function (e.g., such as would indicate an improvement to the technology of machine learning) would not render the claims subject matter eligible, instead constituting no more than mere instructions to apply a judicial exception.
Generally, Examiner notes that what remains of these respective arguments fails to understand or properly consider the distinction between judicial exceptions (particularly abstract ideas) and additional elements, resulting in further failures of each presently recited 101-based argument. The vast majority of the functionality asserted by Applicant, e.g., analyzing data to assign provider certifications, matching of providers with patients, the triggering and performance of consultations between providers and patients, subscription-based funding of a health plan (including determining pricing by way of actuarial models, provider capabilities, and/or insurance premiums), assignment of procedures at least in part based on risk, etc., recite abstract ideas rather than additional elements (see previous and present 101 rejections).
As integration into a practical application under Step 2A, Prong Two (including the asserted improvement to a technology) and embodying of an inventive concept under Step 2B (including by way of the well-understood, routine, and conventional consideration thereof) may only occur by way of any recited additional elements or the combination thereof (see, e.g., MPEP 2106.04(d) and 2106.05), this leaves little with which Applicant may attempt to make such arguments. Improvements to abstract concepts such as Applicant’s asserted “healthcare delivery efficiency” do not constitute improvements to a technology (see MPEP 2106.05(a)). Whether judicial exceptions including abstract ideas (such as all those listed by Applicant in relation to the asserted inventive concept of Claim 11) are well-understood, routine, and conventional is entirely irrelevant to this standard. Indeed, Examiner notes that much of this ground was already well-trod in relation to Parent Application 16508258, the various Office Actions of which already explain, e.g., the distinction between abstract concepts and additional elements and the lack of an improvement to a technology in relation to similar claim draftings of the same overall invention. The explanations and analyses provided therein apply similarly to the claims as presently drafted.
Lastly, what Applicant refers to as “technical steps” are in fact no more than the high-level claiming of abstract steps as being carried out by various computer elements (or programs executed on a computer). Merely claiming the performance abstract steps by way of computers has long been understood as insufficient to evidence subject matter eligible content, not least of all because this is generally the same argument advanced and refuted by the Supreme Court in the seminal Alice case. See also MPEP 2106.05(f) regarding the mere use of computers as tools to perform judicial exceptions.
Claim Rejections – 35 USC § 103
Applicant presents arguments against the previously cited references properly disclosing the first and second machine learning systems of the claims as previously drafted. As the claims as presently amended do not embody any machine learning (as explained above), these arguments are irrelevant. Further, Applicant’s entirely unexplained assertion that Dias is not prior art is incorrect. Examiner’s best attempt to steelman this assertion would be that Applicant believes the claims as presently drafted are entitled to a perfected claim of benefit to not only Non-Provisional 16508256 (filed on 7/10/2019, which Dias pre-dates) but also Provisional Application 62696059 (filed on 7/10/2018). This is not the case, for the reasons explained above. Regardless, Examiner finds that the claims as presently drafted are novel and non-obvious (see below).
Claim Objections
Claims and 12 are objected to because of the following informality: “…services that neither the assigned PBSCP nor the CSP is capable of providing…” should read “…services that neither the assigned PBSCP nor the CSP are capable of providing…” Appropriate correction is required.
Claim Interpretation
In Claims 1 and 11, the language “…to optimize provider-patient matching,” “…to identify conditions requiring specialty care beyond the PBSCP's capabilities,” and “…thereby reducing reliance on procedure-based reimbursements” constitute intended use or intended results, respectively. As such, these passages are not given patentable weight.
In Claims 1 and 11, all instances of “the EHR,” “the patient’s EHR,” and similar are interpreted as relating back to the term “the patient’s electronic health record (EHR) data.”
In Claims 1 and 11, “a first computational analysis system” and “a service assignment system” are not interpreted as structural but rather as indicating software modules, given their explicit modification in the claims as being “executed on a computer.” While “a second computational analysis system” is not similarly modified as being executed on a computer, given the extreme similarity of this term to “a first computational analysis system,” it is interpreted similarly, e.g., as if the claim language read “operating a second computational analysis system, executed on the computer, to automatically trigger…” or similar.
The following is a quotation of 35 U.S.C. 112(f):
(f) Element in Claim for a Combination. – An element in a claim for a combination may be expressed as a means or step for performing a specified function without the recital of structure, material, or acts in support thereof, and such claim shall be construed to cover the corresponding structure, material, or acts described in the specification and equivalents thereof.
The following is a quotation of pre-AIA 35 U.S.C. 112, sixth paragraph:
An element in a claim for a combination may be expressed as a means or step for performing a specified function without the recital of structure, material, or acts in support thereof, and such claim shall be construed to cover the corresponding structure, material, or acts described in the specification and equivalents thereof.
The claims in this application are given their broadest reasonable interpretation using the plain meaning of the claim language in light of the specification as it would be understood by one of ordinary skill in the art. The broadest reasonable interpretation of a claim element (also commonly referred to as a claim limitation) is limited by the description in the specification when 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is invoked.
As explained in MPEP § 2181, subsection I, claim limitations that meet the following three-prong test will be interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph:
(A) the claim limitation uses the term “means” or “step” or a term used as a substitute for “means” that is a generic placeholder (also called a nonce term or a non-structural term having no specific structural meaning) for performing the claimed function;
(B) the term “means” or “step” or the generic placeholder is modified by functional language, typically, but not always linked by the transition word “for” (e.g., “means for”) or another linking word or phrase, such as “configured to” or “so that”; and
(C) the term “means” or “step” or the generic placeholder is not modified by sufficient structure, material, or acts for performing the claimed function.
Use of the word “means” (or “step”) in a claim with functional language creates a rebuttable presumption that the claim limitation is to be treated in accordance with 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph. The presumption that the claim limitation is interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is rebutted when the claim limitation recites sufficient structure, material, or acts to entirely perform the recited function.
Absence of the word “means” (or “step”) in a claim creates a rebuttable presumption that the claim limitation is not to be treated in accordance with 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph. The presumption that the claim limitation is not interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, is rebutted when the claim limitation recites function without reciting sufficient structure, material or acts to entirely perform the recited function.
Claim limitations in this application that use the word “means” (or “step”) are being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, except as otherwise indicated in an Office action. Conversely, claim limitations in this application that do not use the word “means” (or “step”) are not being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, except as otherwise indicated in an Office action.
This application includes one or more claim limitations that do not use the word “means,” but are nonetheless being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, because the claim limitation(s) uses a generic placeholder that is coupled with functional language without reciting sufficient structure to perform the recited function and the generic placeholder is not preceded by a structural modifier. Such claim limitation(s) is/are:
“a telepresence system” of Claims 1 and 11; and
“a plan administration system” of Claim 11.
Because this/these claim limitation(s) is/are being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, it/they is/are being interpreted to cover the corresponding structure described in the specification as performing the claimed function, and equivalents thereof. Particularly, these terms are interpreted in light of Paragraphs 0016-0017, 0030, 0036 and Figs. 3 and 5 as filed.
If applicant does not intend to have this/these limitation(s) interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph, applicant may: (1) amend the claim limitation(s) to avoid it/them being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph (e.g., by reciting sufficient structure to perform the claimed function); or (2) present a sufficient showing that the claim limitation(s) recite(s) sufficient structure to perform the claimed function so as to avoid it/them being interpreted under 35 U.S.C. 112(f) or pre-AIA 35 U.S.C. 112, sixth paragraph.
Claim Rejections – 35 USC § 112
The following is a quotation of the first paragraph of 35 U.S.C. 112(a):
(a) IN GENERAL.—The specification shall contain a written description of the invention, and of the manner and process of making and using it, in such full, clear, concise, and exact terms as to enable any person skilled in the art to which it pertains, or with which it is most nearly connected, to make and use the same, and shall set forth the best mode contemplated by the inventor or joint inventor of carrying out the invention.
The following is a quotation of the first paragraph of pre-AIA 35 U.S.C. 112:
The specification shall contain a written description of the invention, and of the manner and process of making and using it, in such full, clear, concise, and exact terms as to enable any person skilled in the art to which it pertains, or with which it is most nearly connected, to make and use the same, and shall set forth the best mode contemplated by the inventor of carrying out his invention.
Claims 1-20 are rejected under 35 U.S.C. 112(a) or 35 U.S.C. 112 (pre-AIA ), first paragraph, as failing to comply with the written description requirement. The claim(s) contains subject matter which was not described in the specification in such a way as to reasonably convey to one skilled in the relevant art that the inventor or a joint inventor, or for applications subject to pre-AIA 35 U.S.C. 112, the inventor(s), at the time the application was filed, had possession of the claimed invention.
Claims 1 and 11 contain variations on the following limitation: “wherein the computational analysis system generates a certification model that assigns competency scores to providers based on their ability to perform primary and basic specialty care procedures, including at least routine laboratory work, X-rays, and basic pharmacy services, as defined by the service assignment system.” The original disclosure does not contain sufficient written description for this functionality. Specifically, the original disclosure does not properly support the concept of “competency scores,” with the closest disclosure being the vaguely recited and described “expected competency level” of Paragraph 0037. Additionally, what scant description is found in the original disclosure as to how these “competency scores” may be determined/calculated/assigned fails to meet the requirements of written description for computer-implemented functions. From MPEP 2161.01: “claims may lack written description when the claims define the invention in functional language specifying a desired result but the specification does not sufficiently describe how the function is performed or the result is achieved. For software, this can occur when the algorithm or steps/procedure for performing the computer function are not explained at all or are not explained in sufficient detail (simply restating the function recited in the claim is not necessarily sufficient). In other words, the algorithm or steps/procedure taken to perform the function must be described with sufficient detail so that one of ordinary skill in the art would understand how the inventor intended the function to be performed” (emphasis in original). Claims 2-10 and 12-20 are rejected due to their respective dependence upon Claims 1 and 11.
The following is a quotation of 35 U.S.C. 112(b):
(b) CONCLUSION.—The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the inventor or a joint inventor regards as the invention.
The following is a quotation of 35 U.S.C. 112 (pre-AIA ), second paragraph:
The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the applicant regards as his invention.
Claims 1-20 are rejected under 35 U.S.C. 112(b) or 35 U.S.C. 112 (pre-AIA ), second paragraph, as being indefinite for failing to particularly point out and distinctly claim the subject matter which the inventor or a joint inventor (or for applications subject to pre-AIA 35 U.S.C. 112, the applicant), regards as the invention.
Claim 1 contains the following language: “wherein the computational analysis system generates…” In this language, the term “the computational analysis system” is indefinite in that it is unclear as drafted whether this relates to the first computational analysis system or the second computational analysis system. For the purposes of this examination, this term will be interpreted as “the first computational analysis system.” Claims 2-10 are rejected due to their dependence upon Claim 1.
Claims 1 and 11 each contain instances of “the EHR system” (multiple instances in Claim 1). This term lacks antecedent basis, as neither Claim 1 nor Claim 11 previously discloses an EHR system. For the purposes of this examination, these terms will be interpreted as “the EHR data” to maintain proper antecedent basis. Claims 2-10 and 12-20 are rejected due to their dependence upon Claims 1 and 11 respectively.
Claims 1 and 11 contain variations on the following limitation: “wherein the certification model uses the table of procedure-specific risk levels to prioritize assignment of low-risk procedures to PBSCPs based on expected competency levels.” In this limitation, the term “low-risk procedures” is indefinite as a subjective term and a relative term claimed absent a baseline against which it may be measured. What procedures might be considered “low-risk” may reasonably vary from person to person, and neither the claims nor the original disclosure (which only discuss a procedure being “low risk,” and only nominally, in Paragraphs 0037 and 0039) provide some objective standard for measuring the scope of the term. Claims 2-10 and 12-20 are rejected due to their dependence upon Claims 1 and 11 respectively.
Claims 1 and 16, as well as several dependent claims, contain the terms “primary and basic specialty care provider/s (PBSCPs),” “primary care and basic specialty care procedures,” and similar. These terms are indefinite as, while “primary care” and “specialty care” are terms of art in the field of healthcare, “basic” specialty care providers and procedures are not terms of art, and further are subjective terms. The scope of these terms may reasonably vary from person to person, thus rendering the scope of the claims indefinite. The original disclosure does not create a special definition for any of these terms which would render their scope definite, and further, neither the claims nor the specification provides an objective metric by which the scope of such “basic” care providers, procedures, and services may be discerned. For example, the breakdown of Fig. 6 is explicitly identified as exemplary (or “typical”) rather than definitional, and the bounds of the metrics identified as possibly being used to define the scope of “basic” here are likewise indefinite as they contain great variance and may be interpreted in a multitude of different ways (see, e.g., Paragraph 0037). As such, Examiner sees no further details in the original disclosure, the addition of which into the claims would be sufficient to cure this indefiniteness. For the purposes of this examination, the terms “primary and basic specialty care provider/s (PBSCPs),” “primary care and basic specialty care procedures,” and similar will be interpreted as “primary care provider/s,” “procedures,” and similar. Claims 2-10 and 12-20 are rejected due to their dependence upon Claims 1 and 11 respectively.
Claims 2 and 12 contain the term “extraordinary specialist provider,” which is indefinite as a subjective term for the same reasons as the “basic” terms noted above in relation to Claims 1 and 11. Just as the scope of “basic” providers, procedures, and services may reasonably differ from person to person, so too does the scope of an “extraordinary” specialist. As presently drafted, the claims define “extraordinary specialist provider” in part based on the capabilities of PBSCPs. As the scope PBSCPs (and the capabilities thereof) are indefinite as explained above, this renders the scope of terms defined in relation thereto (ie: “extraordinary specialist provider”) indefinite by extension. For the purposes of this examination, the term “extraordinary specialist provider” will be interpreted as “a second consulting specialist provider.”
Claims 6 and 16 contain variations on the following limitation: “wherein said patient is responsible for the subscription-based membership fee that includes an amount related to the patient's portion of the fixed costs necessary to operate the assigned primary and basic specialty care provider.” Firstly, it is unclear as drafted whether the term “the fixed costs necessary to operate the assigned primary and basic specialty care provider” is intended to relate back to “fixed costs of the PBSCP's practice” of Claims 1 and 11 (upon which Claims 6 and 16 respectively depend). Secondly, the scope of “the fixed costs necessary to operate the assigned primary and basic specialty care provider” is indefinite, as what fixed costs might be considered “necessary” in this situation might differ from individual to individual, and no objective metric of determining what fixed costs are “necessary” is defined. For the purposes of this examination, this limitation will be interpreted as “wherein said patient is responsible for the subscription-based membership fee that includes an amount related to the patient's portion of the fixed costs.” Claims 7-9 and 17-19 are rejected due to their dependence upon Claims 6 and 16 respectively.
Claim Rejections – 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-20 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
Regarding Claims 1 and 11, the limitations of certifying primary and basic specialty care providers (PBSCPS); processing a dataset comprising provider qualifications, licensure, equipment capabilities, and a table of procedure-specific risk levels associated with Current Procedural Terminology (CPT) codes; generating a certification model that assigns competency scores to providers based on their ability to perform primary and basic specialty care procedures, including at least routine laboratory work, X-rays, and basic pharmacy services, as defined by the service assignment system; wherein the certification model uses the table of procedure-specific risk levels to prioritize assignment of low-risk procedures to PBSCPs based on expected competency levels; assigning a certified PBSCP to a patient based on the patient's medical needs and the PBSCP's competency scores; correlating the patient's electronic health record (EHR) data with the PBSCP's capabilities to optimize provider-patient matching; providing, by the assigned PBSCP, primary and basic specialty care procedures to the patient, including at least one of in-office X-rays or laboratory diagnostics, using equipment integrated with the EHR system to record procedure outcomes in real-time; automatically triggering a consultation with a consulting specialist provider (CSP) by analyzing the patient's EHR data, including procedure outcomes and diagnostic codes, against a predefined set of clinical thresholds; updating a decision model in real-time based on aggregated EHR data from a patient population to identify conditions requiring specialty care beyond the PBSCP's capabilities; conduct the consultation, including real-time data sharing of the patient's EHR, including diagnostic images and laboratory results, between the patient, the PBSCP, and the CSP, and wherein the CSP provides specialty medical treatment recommendations that are recorded in the EHR for coordinated care delivery; and funding the primary and basic specialty care procedures through a subscription-based membership fee collected by a plan administrator, wherein the membership fee is calculated to cover at least fixed costs of the PBSCP's practice, as determined by an actuarial model based on the patient population's expected utilization of services, thereby reducing reliance on procedure-based reimbursements, as drafted, are processes that, under their broadest reasonable interpretations, cover certain methods of organizing human activity. For example, these limitations fall at least within the enumerated categories of commercial or legal interactions and/or managing personal behavior or relationships or interactions between people (see MPEP 2106.04(a)(2)(II)).
Additionally, the limitations of certifying primary and basic specialty care providers (PBSCPS); processing a dataset comprising provider qualifications, licensure, equipment capabilities, and a table of procedure-specific risk levels associated with Current Procedural Terminology (CPT) codes; generating a certification model that assigns competency scores to providers based on their ability to perform primary and basic specialty care procedures, including at least routine laboratory work, X-rays, and basic pharmacy services, as defined by the service assignment system; wherein the certification model uses the table of procedure-specific risk levels to prioritize assignment of low-risk procedures to PBSCPs based on expected competency levels; assigning a certified PBSCP to a patient based on the patient's medical needs and the PBSCP's competency scores; correlating the patient's electronic health record (EHR) data with the PBSCP's capabilities to optimize provider-patient matching; providing, by the assigned PBSCP, primary and basic specialty care procedures to the patient, including at least one of in-office X-rays or laboratory diagnostics, using equipment integrated with the EHR system to record procedure outcomes in real-time; automatically triggering a consultation with a consulting specialist provider (CSP) by analyzing the patient's EHR data, including procedure outcomes and diagnostic codes, against a predefined set of clinical thresholds; updating a decision model in real-time based on aggregated EHR data from a patient population to identify conditions requiring specialty care beyond the PBSCP's capabilities; conduct the consultation, including real-time data sharing of the patient's EHR, including diagnostic images and laboratory results, between the patient, the PBSCP, and the CSP, and wherein the CSP provides specialty medical treatment recommendations that are recorded in the EHR for coordinated care delivery; and funding the primary and basic specialty care procedures through a subscription-based membership fee collected by a plan administrator, wherein the membership fee is calculated to cover at least fixed costs of the PBSCP's practice, as determined by an actuarial model based on the patient population's expected utilization of services, thereby reducing reliance on procedure-based reimbursements, as drafted, are processes that, under their broadest reasonable interpretations, cover mental processes. For example, these limitations recite activity comprising observations, evaluations, judgments, and opinions (see MPEP 2106.04(a)(2)(III)).
Additionally, the limitations of generating a certification model that assigns competency scores to providers based on their ability to perform primary and basic specialty care procedures, including at least routine laboratory work, X-rays, and basic pharmacy services, as defined by the service assignment system; wherein the certification model uses the table of procedure-specific risk levels to prioritize assignment of low-risk procedures to PBSCPs based on expected competency levels; and funding the primary and basic specialty care procedures through a subscription-based membership fee collected by a plan administrator, wherein the membership fee is calculated to cover at least fixed costs of the PBSCP's practice, as determined by an actuarial model based on the patient population's expected utilization of services, thereby reducing reliance on procedure-based reimbursements, as drafted, are processes that, under their broadest reasonable interpretations, cover mathematical concepts. For example, these limitations recite mathematical relationships and/or calculations (see MPEP 2106.04(a)(2)(I)).
If a claim limitation, under its broadest reasonable interpretation, covers fundamental economic principles or practices, commercial or legal interactions, managing personal behavior or relationships, or managing interactions between people, it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation in the mind or with the aid of pen and paper but for recitation of generic computer components, it falls within the “Mental Processes” grouping of abstract ideas. If a claim limitation, under its broadest reasonable interpretation, covers mathematical relationships, mathematical formulae or equations, or mathematical calculations, it falls within the “Mathematical Concepts” grouping of abstract ideas. Accordingly, the claims recite an abstract idea.
The judicial exception is not integrated into a practical application. In particular, the claim recites the additional elements of a computer-implemented healthcare delivery system, a first computational analysis system and a service assignment system executed on a computer, equipment integrated with the EHR data, a second computational analysis system, a telepresence system enabling real-time data sharing, and a plan administration system.
A computer-implemented healthcare delivery system, a first computational analysis system and a service assignment system executed on a computer, a second computational analysis system, a telepresence system enabling real-time data sharing, and a plan administration system, in the context of the claims as a whole, amount to no more than mere instructions to apply a judicial exception (see MPEP 2106.05(f)). Equipment integrated with the EHR data, in the context of the claims as a whole, amounts to no more than generally linking the use of a judicial exception to a particular technological environment or field of use (see MPEP 2106.05(h)). Accordingly, these additional elements do not integrate the abstract ideas into a practical application because they do not, individually or in combination, impose any meaningful limits on practicing the abstract ideas. The claims are therefore directed to an abstract idea.
The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the judicial exception into a practical application, the additional elements amount to no more than mere instructions to apply a judicial exception and generally linking the use of a judicial exception to a particular technological environment or field of use for the same reasons as discussed above in relation to integration into a practical application. These cannot provide an inventive concept. Therefore, when considering the additional elements alone and in combination, there is no inventive concept in the claims, and thus the claims are not patent eligible.
Claims 2-10 and 12-20, describing various additional limitations to the method of Claim 1 or the system of Claim 11, amount to substantially the same unintegrated abstract idea as Claims 1 and 11 (upon which these claims depend, directly or indirectly) and are rejected for substantially the same reasons.
Claims 2 and 12 disclose referring the patient to an extraordinary specialist provider for services that neither the assigned PBSCP nor the CSP is capable of providing or that require a medical consultation from the extraordinary specialist provider (an abstract idea in the form of a certain method of organizing human activity and a mental process), which does not integrate the claims into a practical application.
Claims 3 and 13 disclose the subscription-based membership fee for primary and basic specialty care is calculated at least in part from at least one of: service cost, service requirements, policies, the providers, the practitioners of the providers, said practitioners’ skill levels and capabilities, services the provider is capable of offering at the moment, and services the provider can become capable of providing (further defining the abstract idea already set forth in Claims 1 and 11), which does not integrate the claims into a practical application.
Claims 4 and 14 disclose wherein the certified PBSCP is required to offer a baseline of basic specialty procedures (further defining the abstract idea already set forth in Claims 1 and 11), which does not integrate the claims into a practical application.
Claims 5 and 15 disclose wherein said baseline comprises at least one of: injections, allergy testing, spirometry, skin excision and biopsy, laser treatment and removal, hypertension and cholesterol management, noninvasive cardiovascular testing, AICD and pacemaker management, casting and repair of minor bone fractures, minor orthotics, menopausal hormone replacement, diabetes management, dialysis, optometry, and providing corrective lenses (further defining the abstract idea already set forth in Claims 4 and 14), which does not integrate the claims into a practical application.
Claims 6 and 16 disclose wherein said patient is responsible for the subscription-based membership fee that includes an amount related to the patient’s portion of the fixed costs necessary to operate the assigned primary and basic specialty care provider (further defining the abstract idea already set forth in Claims 1 and 11), which does not integrate the claims into a practical application.
Claims 7 and 17 disclose wherein the subscription-based membership fee includes an amount related to contributions to a risk pool sufficient to cover at least one of: the variable costs of the patient, and the costs for service of additional specialty providers (further defining the abstract idea already set forth in Claims 6 and 16), which does not integrate the claims into a practical application.
Claims 8 and 18 disclose wherein the subscription-based membership fee includes an amount related to premiums necessary to enable the procurement of insurance, comprising at least one of commercial insurance and enterprise self-insurance, to cover at least one of: variable costs of the patient, and costs for service of additional specialty providers (further defining the abstract idea already set forth in Claims 6 and 16), which does not integrate the claims into a practical application.
Claims 9 and 19 disclose wherein a patient portion of a claim of said insurance is handled and at least in part paid by the plan administrator of said medical plan wherein the patient does not need to receive a demand for the patient portion of the claim when the plan administrator pays the patient portion of the claim in full (an abstract idea in the form of a certain method of organizing human activity and a mental process), which does not integrate the claims into a practical application.
Claims 10 and 20 disclose wherein said consulting specialist provider performs consultations remotely with the patient and the certified PBSCP using access to the patient’s electronic health record (further defining the abstract idea already set forth in Claims 1 and 11), which does not integrate the claims into a practical application.
Novel/Non-Obvious Subject Matter
Claims 1 and 11 contain novel and non-obvious subject matter. The following is a statement of reasons for the indication of novel and non-obvious subject matter: None of the prior art of record, taken individually or in combination, teach or suggest the specific series of logical operations of Claims 1 and 11. In particular, the prior art, taken individually and in combination, does not teach or suggest the following series of logical operations in the context of systems and methods recited for providing healthcare services:
operating a first computational analysis system and a service assignment system executed on a computer to certify primary and basic specialty care providers (PBSCPs),
wherein the first computational analysis system processes a dataset comprising provider qualifications, licensure, equipment capabilities, and a table of procedure-specific risk levels associated with Current Procedural Terminology (CPT) codes,
wherein the computational analysis system generates a certification model that assigns competency scores to providers based on their ability to perform primary and basic specialty care procedures, including at least routine laboratory work, X-rays, and basic pharmacy services, as defined by the service assignment system, and
wherein the certification model uses the table of procedure-specific risk levels to prioritize assignment of low-risk procedures to PBSCPs based on expected competency levels;
assigning, via the service assignment system, a certified PBSCP to a patient based on the patient's medical needs and the PBSCP's competency scores,
wherein the service assignment system correlates the patient's electronic health record (EHR) data with the PBSCP's cap